There is an increasing number of people in England who are acutely unwell, many of whom are older and living with frailty. However, the acute care pathways in our hospitals are at risk of becoming overwhelmed, reducing the function of elective activity. We therefore need to find ways to meet the needs of these people without admitting them to hospital.
The Acute Care Interfaces theme of ARC West Midlands have undertaken research on alternatives to acute hospital admission.
Background
The NHS England Virtual Ward Programme initially focused on remote monitoring, but our research showed the need to broaden out to Point of Care (POC) diagnostic testing and acute medical intervention, delivering a ‘hospital at home’ model. We initially studied how POC diagnostic blood testing can be used to support acute medical care decision-making without requiring hospital admission. We then studied POC ultrasound in acute medical care settings during the COVID-19 pandemic, finding that we could replace traditional chest x-rays. We implemented these findings into new hospital-at-home services in Birmingham and Oxford, being the first services to incorporate both POC blood tests and imaging in the home and care home setting. We were able to deliver the first use of an acute monoclonal antibody as part of successful treatment for COVID pneumonitis in the home without any transfer to hospital.
Hospital at Home
Hospital at Home is a service that provides acute and sub-acute care by healthcare professionals in private or care homes for a condition that would otherwise require acute hospital inpatient care. It treats people with a wide range of conditions in a variety of contexts, with particular interest in the provision of services for older people living with frailty.
Through NHS England evaluation funding, ARC West Midlands have analysed the processes of care and impact of hospital at home services in the West Midlands. We then developed a programme theory for Hospital at Home (funded by NIHR Policy Research Programme) showing the steps that providers and policy makers can take to speed up adoption, spread and impact of Hospital at Home care, and to understand how the current provision of Hospital at Home in the UK can support delivery of certain hospital-level care processes in community settings.
Our work on Hospital at Home Programme Theory will support clinical teams and health service managers in understanding how to strengthen and develop services. We have supported a national community of practice as a result of our research through the support for, and leadership of, the UK Hospital at Home Society and ARC West Midlands researchers designed and led the first in person conference (240 delegates from 74 hospital at home services across the UK).
Older adults with frailty can now have advanced diagnostics and acute medical treatment without leaving their home or care home. This provides real choice over location of care and can ensure that advanced care plans for treatment can incorporate acute hospital at home. People will no longer need to accept poorer acute care if they choose to stay at home.
This work has been cited in NHS England Policy Documents, presented in briefing packs to the Secretary of State for Health, given as evidence to a House of Lords health policy committee, and widely disseminated through various BBC outlets, including the BBC news website and an in-depth panorama programme showing real-time acute patient care, ‘The NHS Crisis: Can It Be Fixed?’. It has also led to Hospital at Home being named within the Department of Health and Social Care (DHSC) Areas of Research Interest. Our work presenting a programme theory of the impact of Hospital at Home will also be cited in new NHS England Operational Guidance for Hospital at Home Services. Prof Daniel Lasserson was also invited to deliver a Distinguished Lecture in Ireland, where he also provided various interviews (read more at: https://www.arc-wm.nihr.ac.uk/hospitals-at-home/).
The contribution of NIHR ARC West Midlands has been to support, foster and provide methodological support to Prof Lasserson and his team, as well as utilise links made to the West Midlands Health Innovation Network and provider organisations as part of our strategy for implementation. ARC West Midlands researchers led by Prof Lasserson, through externally acquired funding, have developed a greater understanding of how to strengthen acute hospital at home services and new fields of inquiry have been initiated. We will continue to influence policy makers through membership of the NHS England National Clinical Advisory Group and publications. Our imminent research plans include a UK wide bench-marking survey of processes of care and clinical outcomes in different hospital at home services. This will give us a clearer guide on the optimal organisational model for Hospital at Home which we will disseminate through policy networks, professional networks and NIHR communications networks.
Key Papers
- Description of Programme Theory for Hospital at Home
https://bmchealthservres.biomedcentral.com/articles/10.1186/s12913-024-10619-7
- Care Pathways for Older Adults with frailty
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10811520/pdf/afad257.pdf
- Healthcare Staff perceptions of barriers and facilitators for Hospital at Home
https://jamda.com/retrieve/pii/S1525861023009568